by Dr Edwin Kruys

Unfreeze the freeze: A storm is coming

I was really glad to hear Health Minister Sussan Ley say at the annual AMA conference in Brisbane: “The Government is not claiming we’re in a healthcare funding crisis.”

At the same time dark clouds are gathering as the frustration about the patient Medicare rebate freeze rises.

The Medicare rebate is the amount patients get back from Medicare after they visit their doctor. This amount is supposed to go up every year to compensate for inflation and higher costs. The government has frozen the annual indexation for four years.

The Consumers Health Forum said in its analysis of the latest Budget: “The retention of the $1.67 billion freeze in Medicare payments to doctors may mean many patients are likely to face higher medical bills.”

The Guardian reported: “The AMA president, Brian Owler, used his opening address on Friday to call for both sides of politics to lift the ‘damaging’ freeze which could force GPs to start passing costs on to their patients, amounting to a so-called co-payment by stealth.”

And: “The federal government could face another fierce campaign from one of the nation’s most powerful lobby groups if it does not lift its freeze on doctors’ rebates before the next election.”

It looks like we’re going to get some fireworks again. If consumers, GP groups and the AMA will join forces, the government is going to get a hard time, especially since there is no healthcare funding crisis.

7 thoughts on “Unfreeze the freeze: A storm is coming”

This week, we’ve seen doctors complaining about a new medical school and agitating for more of other people’s money from the government. Both positions confirm what most people knew anyway: the medical industry in this country are welfare queens who are always demanding more of someone else’s money, and to be protected from competition.

Re the new medical school: Many graduating medical students and junior doctors around Australia are currently unable to find quality training positions due to a lack of available places. The Australian medical students organisation reminds us that the number of medical students from WA has tripled over the past decade. Training one medical student costs the community over $100,000. It seems common sense to make sure the current graduating students and doctors are able to enter the healthcare system first, before we spend our tax dollars to put more students in the pipeline.

I know it’s hard to believe for some, but most GPs are genuinely concerned that many of their patients are unable to contribute to their doctor’s visit. Hence the campaign against the copayment. Hence the frustration about the freeze. We do care.

You said the amount of the Medicare rebate “is usually increased every year to compensate for inflation and higher costs”. This is not true, because we all know that the increases in Medicare benefits, if any (there have been one in some years), do NOT compensate for inflation and higher costs.

The truth is that any increases in Medicare benefits are calculated by the government of the day to be just enough to keep the bulk billing rate above some figure that the government of the day feels is acceptable. I suspect that that figure is around 80%. That is why, when our current Prime Minister was Health Minister and the bulk billing rate fell (? to < 80%), Medicare benefits were increased by a much larger amount than usual – and that had the effect desired by the government.

The government takes the fact that GPs bulk bill a substantial proportion, or in some practices all of their patients, as evidence that the current Medicare benefits are in fact high enough. It’s that simple. Quality of care doesn’t come into the equation. It’s that simple.

There are a finite amount of ‘healthcare dollars’. GPs have different views on how these should be spent. The RACGP and the AMA should be communicating the views of their members to the government of the day. Instead, they seem to be discussing many other issues while other professional groups out lobby them. Given that, I’m just going to do the best job I can for my patients under the regime of the day. Expecting manna from heaven is likely to be an exercise in futility. Oliver’s points are spot on and while I don’t agree with the first commenter, I completely see where they’re coming from.

What i don’t understand is the restriction of trainee placements. Is it a pure funding issue? From the (very limited) amount I have read, it seems that placements are tightly controlled by the Colleges and Associations. Externally it seems a cynical approach of keeping supply low, demand high and fees exorbitant – I am speaking more of specialists and surgeons than GPs.

Having spent the last decade in (and sometimes battling) the medical system as a carer, I am very jaded. The high fees, long wait times to get an appointment. The restrictions in availability in both public and private system (top hospital and extras cover) often leads us to despair.

And to hear there is a glut of graduands that are being artificially? held from entering further training really does leave me flat.

Of course someone has to pay for it, as both my tax contribution and out of pocket expenses can attest. I am all for raising the medicare levy if the system is not sustainable. but to restrict the supply of medical professionals when waiting lists are ever on the increase is intolerable.

Another example, I recently had a relative involved on the wrong side of a pedestrian vs car collision. They were transferred to one of the big Melbourne A&E departments for surgery. it was a weekend and the surgical team and rest of the ER staff were out on their feet. It was clear they were toward the end of a long shift with back to back difficult cases. Having a chat with a few of them, it was no way out of the ordinary, just another Sat night in ER.

These circumstances are surely unsustainable. As you expect highest rate of burnout occurs for these hardest working of doctors, nurses and technicians. So why exacerbate the problem by having 8 to 12 hour shifts? Again if there is a queue of people desirous of training and/or graduands waiting for placement get ’em in there. reduce shift lengths, burnout, fatigue, etc and thereby improve patient care.